Comparative study of PEP mask and Flutter on expectoration in cystic fibrosis patients.

The objective of the study was to investigate the effect of positive expiratory pressure (PEP) and Flutter on expectoration in cystic fibrosis (CF) patients. Data was gathered through 260 treatments with 10 patients (5 female; 19.2 years; BMI: 18.0). Two methods were used alternately, first the patients started with Flutter and proceeded with PEP, and the next occasion they exercised in the reverse order, starting with PEP then continuing with Flutter. During each phase, 5 sets of 10 exhalations were performed. Sputum weight was measured after the use of the first device, and at the end of the treatment. During sessions starting with Flutter 4.0 ± 4.0 g sputum was expectorated, continuing with PEP, an additional 5.2 ± 5.0 g was produced, altogether 9.2 ± 8.2 g. At sessions starting with PEP 7.4 ± 3.7 g was expectorated, continuing with Flutter an additional 0.8 ± 1.4 g, that is 8.2 ± 4.1 g. Comparing the two devices by themselves, PEP proved to be significantly more efficient then Flutter. Comparing the two treatment types it is statistically not proven, which one is preferable using both devices. Conclusively, PEP is significantly more efficient than the Flutter in sputum expectoration among CF patients. The Flutter is a useful supplementary device.

Toxocariasis associated with chronic cough in childhood: a longitudinal study in Hungary.

Chronic cough lasting 8 weeks or more often seems to be an intractable problem in childhood. Toxocara infection is associated with an increased prevalence of airway symptoms and may be the possible aetiological agent of chronic cough. Of 425 children aged 2-17 years with chronic cough who were investigated for toxocariasis and the distribution of bronchial asthma (BA), cough variant asthma (CVA) and non-asthmatic eosinophilic bronchitis (NAEB), 136 (32%) were seropositive for Toxocara canis antigens. Ninety-three of the 136 were adequately assessed, diagnosed and followed up during 1 year. BA was diagnosed in 40%, CVA in 27% and NAEB in 33% of the children. The eosinophil cell count, serum T. canis IgG levels and symptoms are predictors of the improvement or the decline of the condition. Presuming the aetiopathogenetic role of T. canis in the inflammatory process of chronic cough, we treated the children not only with inhaled corticosteroid (ICS), but also with a 1-week course of anthelminthics. We could significantly decrease the dose of ICS in 23 (62%) of the 37 with BA. The administration of anthelminthics and the avoidance of sensitizers were sufficient for those with NAEB; none needed ICS. ICS therapy could be stopped 2-3 months later in 17 (68%) of the 25 with CVA. We found that 8 of the 25 with CVA (32%) presented asthmatic symptoms at the end of the 1-year period. In Hungary, T. canis may be a potential sensitizer for chronic cough in seropositive children. Deworming therapy will then alleviate the airway symptoms without exacerbation in patients with BA, and have a positive effect on those with NAEB and the majority of those with CVA.

Effects of magnesium supplementation on the glutathione redox system in atopic asthmatic children.

OBJECTIVE: Our aim was to investigate the effects of 12-week oral magnesium (Mg) supplementation on the RBC redox system in stable, persistent, moderately asthmatic children (N = 40, 24 boys, 16 girls) aged 4-16 years in a randomized, double-blind, placebo-controlled study. DESIGN: Oxidized (GSSG) and reduced (GSH) glutathione, oxyhaemoglobin, methaemoglobin (metHb), hemichrome and bilirubin levels before and after treatment were determined, and GSH stability tests were performed. RESULT: The GSH concentration was significantly higher in the Mg-treated than in the placebo-treated patients after the treatment period. There was a positive correlation between the decreased plasma metHb and hemichrome levels and the decreased plasma haemoglobin concentrations in the Mg-treated patients at the end of the study. CONCLUSION: Mg in the given doses exerts antioxidant activity and influences the glutathione redox system.

Randomized comparison of the efficacy and safety of ciclesonide and budesonide in adolescents with severe asthma.

BACKGROUND: The aim of the study was to investigate the efficacy and safety of ciclesonide compared with budesonide in adolescents with severe asthma. METHODS: In this randomized, double-blind, double-dummy, parallel-group study, patients aged 12-17 years with severe asthma were treated with budesonide 400 microg once daily (QD) in a 2-week run-in period. At randomization, eligible patients were assigned 2:1 to ciclesonide 320 microg QD (ex-actuator) or budesonide 800 microg QD (metered dose), respectively, in the evening. Forced expiratory volume in 1s (FEV(1)) was the primary variable. Patients recorded asthma symptom score and rescue medication use in diaries. Safety assessments included adverse events (AEs) and 24-h urine cortisol. RESULTS: Four hundred and three patients were randomized. Ciclesonide 320 microg QD and budesonide 800 microg QD significantly increased FEV(1) (least-squares mean: 505 and 536 mL, respectively; both p<0.0001 versus baseline) in the intention-to-treat (ITT) population. Lower limits of the 95% confidence intervals (ITT: -138 mL; per-protocol: -122 mL) were above the non-inferiority limit (-150 mL). Median percentage of days without asthma symptoms and without rescue medication use was 84% with ciclesonide and 85% with budesonide. AEs were unremarkable, with no cases of confirmed candidiasis. Median creatinine-adjusted urine cortisol significantly decreased with budesonide treatment (15.9-13.7 nmol cortisol/mmol creatinine; p=0.0086 versus baseline), but not with ciclesonide (p=0.1125). CONCLUSIONS: Ciclesonide 320 microg QD showed similar efficacy to budesonide 800 microg QD in adolescents with severe asthma. Ciclesonide was well tolerated and, unlike budesonide, had no effect on urine cortisol levels. CLINICAL TRIAL REGISTRATION NUMBER: EudraCT No.: 2004-001233-41.

[Ultrastructural study of bronchial mucosa in suspicion of ciliary dyskinesia]. / A hörgónyálkahártya ultrastrukturális vizsgálata ciliaris dyskinesia gyanúja esetén.

In the ciliary dyskinesia (immotile cilia syndrome) shows the partial or total lacking of cilia's elements. The ciliary dyskinesia may be developed congenital or acquired. The authors report on the experience with 72 biopsies from bronchial mucosa of 68 children, submitted with the question of immotile cilia syndrome. On micrographs (M: 64,000x) of the specimens processed by routine electron microscopical method the number of outer and inner dynein arm, A and B peripheral tubules, central tubules and central sheet were determined to normal 9 + 2 structure. 50-100 ciliaris per case were examined. Total or partial lacking of dynein and non-dynein elements were expressed for the total number of ciliaris compartments. Considering any earlier quantitative examination with this expression there was ease to characterised the quantitative behaviour of the components of ciliaris. Seven Kartagener's syndrome cases was the positive control for determined the quantitative differences between the primer and secondary ciliary changes. In the primary ciliary defects where the situs inversus were presented the total lacking of outer or/and inner dynein arms, where the situs inversus were not presented only the total lacking of inner dynein arms could be found. In secondary ciliary defects the partial lacking of the dynein arms and tubular components were presented. The used method is suitable to characterise the primary or secondary ciliary defects of bronchial mucosa.

Allele frequencies of cystic fibrosis-linked markers and F508 deletion in affected Hungarian families.

Linked marker haplotype analysis of 16 cystic fibrosis (CF)-affected children, 3 fetuses, 1 healthy child and their parents was performed by restriction fragment length polymorphism (RFLP) for J3.11, Met H, Met D, XV-2c, KM.19 markers. Polymerase chain reaction (PCR) to detect the main mutation of CF chromosome, a specific 3 base pair (bp) deletion (delta F508) was also performed in 17 CF patients. Allelic frequencies on analysed CF chromosomes were: J3.11/Taq I 1.0, 0.0, J3.11/Msp I 0.44, 0.56, Met H/Taq I 0.73, 0.27, Met H/Msp I 0.80, 0.20, Met D/Taq I 0.75, 0.25, XV-2c/Taq I 0.85, 0.15, KM.19/Pst I 0.17, 0.83 for allele 1 and 2, respectively. Two markers, Met H and KM.19 were found to be in strong association with the CF mutation. The frequency of the delta F508 mutation on all 34 CF chromosomes was 0.65 (of which 0.73 was homozygous and 0.27 heterozygous for this deletion).

Examination of the role of oxygen free radicals in bronchial asthma in childhood.

The antioxidant enzyme activities, the lipid peroxidation level, the parameters of glutathione metabolism, and the proportion of haemoglobin oxidation products were determined during the symptom-free period of childhood bronchial asthma. A decreased catalase activity and a significantly reduced glutathione instability were demonstrated as compared to the controls. The results indicate that antioxidant protection of the haemoglobin molecule in asthmatic children is considerably decreased.

[Comparative study of ketotiphen and oxatomide (repeated skin- and nasal provocation)]. / Ketotifen és oxatomide összehasonlító vizsgálata (ismételt bör- és nasalis provokációban).

The authors report a comparative study on the effects of ketotifen and oxatomide on repeated provocation of the skin and the nasal mucosa in 16 children (4 girls and 12 boys, average age 12.0 +/- 3.25 yr) with diagnosed seasonal allergic rhinitis. Preceding and following a 4-week ketotifen or oxatomide treatment, a quantitative prick skin test was performed and evaluated by planimetry and a specific nasal provocation (SNP) was performed and objectivated by rhinothermometry. Both the oedematous skin reactions induced by histamine and allergen and the clinical and thermal scores obtained by direct observation of the shock organ (SNP) were decreased more strongly by ketotiten than by oxatomide. The results of preseasonal in vivo pharmacodynamic studies are expected to permit more effective, individual medication before the pollen season or at the first sign of the symptoms.

Examination of red blood cell deformability in cystic fibrosis.

The red blood cell deformability was determined in 20 children suffering from cystic fibrosis (CF), and the results were compared with the data on 20 healthy children. In CF, a pronounced impairment of the deformability was found.

Serum complement C2 levels in patients suffering from cystic fibrosis (CF).

Serum C2 complement levels were measured in 17 children suffering from CF, 17 with obstructive bronchitis, and 7 control children. No correlation was found between the C2 level and the clinical stage in Shwachman score, the HLA B7 or B18 antigens and the ventilation functional parameters. The mean serum C2 complement level did not differ in the three investigated groups, but in 5 of the 17 CF patients the serum C2 was diminished according to the possibility of C2 complement heterozygosity. The CF patients with diminished C2 complement levels exhibited HLA B7, B12 or B35 antigens. The serum C2 complement levels were significantly higher in the HLA B18 antigen-carrier CF homozygotes.

Beta-adrenergic receptors of lymphocytes in children with allergic respiratory diseases.

The beta-adrenergic receptor binding sites on peripheral lymphocytes in children with bronchial asthma (n = 16) and seasonal allergic rhinitis (n = 8) were examined in comparison with normal controls (n = 18) by means of 124I-cyanopindolol. The number of beta-adrenergic receptors was significantly lower in the asthmatic group (858 +/- 460/lymphocyte) than in the controls (1564 +/- 983/lymphocyte). The value (1891 +/- 1502/lymphocyte in children with allergic rhinitis was slightly higher than that in healthy controls. Of the 24 patients suffering from allergic diseases of the lower or upper airways, the bronchial histamine provocation test was performed in 21; 16 gave positive results, while 5 were negative. No difference in beta-adrenergic receptor count was found between the histamine-positive and negative patients. Neither was there any correlation between the number of beta-adrenergic receptors and the high (16/24) and low (8/24) serum IgE concentrations found in allergic patients. The significant decrease in beta-adrenergic receptor count in asthmatic children lends support to Szentiványi's concept. Further qualitative and quantitative analysis of lymphocyte beta-adrenergic receptors may provide an individual approach to the treatment of bronchial asthma with beta-sympathomimetic drugs.

Spontaneous and stimulated lymphocyte transformation test in homozygous children with cystic fibrosis.

Spontaneous and non-specific mitogenic stimulated lymphocyte transformation tests of cellular immune function were carried out. The phytohaemagglutinin, concanavalin A and pokeweed mitogen stimulated lymphocyte transformation was significantly diminished in the group of cystic fibrosis (CF) homozygotes as compared to the controls, as an indication of the impaired reactivity of the T-lymphocytes. The spontaneous phytohaemagglutin stimulated lymphocyte transformation ratio was diminished, too.

Activity of the lysosomal cysteine proteinases (cathepsin B,H,L) and a metalloproteinase (MMP-7-ase) in the serum of cystic fibrosis homozygous children.

Lysosomal cysteine proteinase (cathepsin B, H, L) and metalloproteinase (MMP-7-ase) activities were measured from serum of 19 cystic fibrosis (CF) homozygotes and of 13 healthy children, as control group. The activity of cathepsin B and H significantly increased in the CF-group.

Promotion by sodium bromide of functional synapse formation from foreign nerves in the superior cervical ganglion of adult rat with intact preganglionic nerve supply.

The possible effect of sodium bromide (NaBr) (a substance with known inhibitory action on synaptic transmission) was studied on synapse formation with foreign nerves, implanted into the superior cervical ganglion of adult rats. It was found that in spite of the presence of preganglionic nerve supply, both implanted nerves (n.XII and n.X, respectively) were enabled to establish functional synapses with the principal ganglion cells in NaBr-treated animals. In contrast, synapse formation was almost absent in ganglia of sodium chloride drinking (control) rats with intact preganglionic nerve supply. This effect of NaBr is considered to be analogous to that of GABA, whose promoting action on synaptogenesis in adult rat superior cervical ganglion has been previously described.